Anastomosis surgical instruments



Aug. 9, 1966 J. E. HEALEY, JR, ETAL 3,

ANASTOMOSIS SURGICAL INSTRUMENTS Filed July 16, 1965 Sheets-Sheet 1 n5.E I

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ANASTOMOSIS SURGICAL INSTRUMENTS Filed July 16, 1965 4 Sheets-Sheet 5INVENTQRS John E. Heuqy, (/71, E Bailey Moo/"e ORNEY6' fl- 9, 1956 J. E.HEALEY, JR. ETAL 3,265,069

ANASTOMOSIS SURGICAL INSTRUMENTS V Fil ed July 16, 1965 4 Sheets-Sheet 4day. 17.

INVENTORS John E. Hadley Jn, E. fiwz'ley Moore WQ ykzzwm ATTORNEYSUnited States Patent 3,265,069 ANASTOMOSIS SURGIQAL INSTRUMENTS John E.Henley, in, 32% Gakrnont St, Houston, Tex., and Edwin E. Moore, 48%Bellview Sh, Beilaire, Tex. Filed July 16, 1965, Ser. No. 380,541 6Claims. (U. 128-334) This application is a continuation-in-part of ourearlier application, Serial No. 216,944, filed on August 7, 1962, forSurgical Instrument, which in turn is a continuationin-part of SerialNo. 161,984, filed on December 26, 1961, both now abandoned.

The invention hereinafter described relates to devices or instrumentsfor use by surgeons in the rejoining of body ducts which in the courseof operations have been severed. 'Thus, more particularly stated, thedevices are especially adapted for anastomosis, and are useable in therejoining of various body ducts including such as bile ducts, bloodvessels, and the intestinal tract.

It hardly needs to be emphasized that the element of time in thecompletion of an operation is one of great importance. As has been thecase prior to this invention, the rejoining of a single body ductusually has required fifteen to thirty minutes and, in some cases,substantially more time. This time is occupied by the careful joining ofthe severed ducts and their suturing to the point of complete closure.The instruments provided according to the present invention permit thisportion of the surgeons task to be accomplished in a remarkably shorttime, in most instances from about three to five minutes. The actualstep of bringing the ends of the ducts together is rendered exceedinglysimple, positive, and once the ducts are in apposition, the new devicesmaintain a perfect meeting of the portions of the ducts which are to berepaired without the necessity for the surgeon taking further steps toassure freedom from leakage and excessive damaging pressure upon thecells of the tissue.

The devices of the invention are exceedingly simple in theirconstruction, and because of their structural design, they are free ofdifiicult cleaning problems. The matter of cleanliness of instruments isone not to be overlooked since tiny crevices, cavities, and other designfeatures do not permit certain cleansing, as a result of which,infections are introduced into the body at the site of the operation inthe course of the surgery.

The new devices of this invention possess still another importantattribute from the standpoint of the surgeon in that they are believedto be substantially the ultimate in ease of use and may be so utilizedwith the knowledge that the instruments are substantially beyond havingthe capacity to inflict injury or otherwise aggravate the tissue of thepatient. Moreover, the association of their relatively few but importantparts is accomplished in such a manner as to render the possibility ofparts being left within the patients body most unlikely.

Before proceeding to set forth a description of the new devices indetail, it is desired to provide a general description of the type ofdevice contemplated by the invention. It will be understood that deviceswhich are within the spirit of the invention but which differ instructural design from the specific forms more particularly presented bythe drawings and descriptive material of this specification, may bedevised to accomplish the anastomosis of body ducts. For purposes ofillustrating the invention, the drawings illustrate two forms of devicescoming within the invention.

The present invention contemplates a device having two principalelements mounted [for movement relative to each other, each of saidprincipal elements carrying a cylindrical head portion through which theends of body ducts are passed, turned back over the outside thereof,

Patented August 9, 19

ice

i.e., the body ducts are cuffed, means being provided either as a partof the device itself or as a co-operating separate part for maintainingthe cuffed ducts in position, and means adapting the device for handoperation, e.g., for forceps-type handle portions, to effect movement ofthe cylindrical head members to a meeting point, thereby bringing thecuifed portions of the ducts into apposition, and finally, means formaintaining positive apposition under predetermined pressure. It will beunderstood that the employment of a device of the character justdescribed results in the intolerable situation that the cylindricalheads surround the body duct after suturing and cannot be removed unlessmeans are provided permitting removal. The devices of this inventionovercome this difliculty.

In one of the forms of the invention illustrated in the drawings, inorder that the two principal elements may be readily removed, thecylindrical head portions comprise three elements, one being a circularouter sleeve-like element, hereinafter referred to as a sleeve, formedto a generally circular configuration except that the circle is notclosed, there being enough space between the ends of the unclosed sleeveto permit it to be slipped over the body duct, the other two partsforming a cylindrical bushing remov-ably fitting tightly within theouter sleeve part so that when in position within the outer sleeve, aclosed circular channel is provided for fully surrounding the bodyducts, and when removed, easy removal of the cylindrical head portionfrom the body duct is afforded.

In the second form of the invention illustrated in the drawings, thecylindrical head portions are composed of separable arcu-ate sections,one of the sections being mounted upon a spring-urged lever arm which inturn is mounted upon the shank portion of the forceps ele ments. Thespring normally biases the lever arm in a manner to position thesections of the cylindrical heads together so that a closed circularchannel is formed. When it is desired to remove the forceps elements andthe attached cylindrical head portions from their position surroundingthe ducts, the lever arm is actuated thereby moving the attached sectionout of position and providing a passageway in the cylindrical headpermitting the instrument to be drawn away.

For the purposes of illustration and explaining the operation of thedevices of the inventon, they are described with respect to use inrejoining a severed blood vessel; however, as indicated above, they maybe employed in any similar anastomosis operation. Moreover, reference ismade to suturing as the method of rejoining the severed blood vessels,but it will be understood that any other acceptable method such asstapling or adhesion may be employed.

The invention herein is illustrated by drawings in which the preferredforms thereof are shown in detail.

In the drawings, FIGURE 1 is a view in side elevation showing one formof the device of this invention with its parts assembled.

FIGURE 2 is a view of FIGURE 1 in side elevation showing one of the twoprincipal parts of the device with the bushing elements in place withinthe outer sleeve portion, thus completing the cylindrical head assemblyreferred to hereinbefore.

FIGURE 3 is a view of the second and complementary principal part of thedevice of FIGURE 1 in side elevation.

FIGURE 4 is an enlarge-d perspective vie-w of one of the cylindricalhead assemblies as is carried by each of the two parts of FIGURES 2 and3 showing the bushing assembly removed but oriented for association withthe outer sleeve.

FIGURE 5 is an end view of the cylindrical head portion of FIGURE 4showing the bushing in position.

FIGURE 6 is a vertical sectional view through the cylindrical heads anda blood vessel in position for suturing.

FIGURE 7 is a fragmentary portion of the pIlnClPai part shown in FIGURE2, the fragmentary portion being enlarged and illustrating in detail themeans for associating the two principal parts for relative movement.

FIGURE 8 is a side view of FIGURE 7.

FIGURE 9 is a similar fragmentary view of the principal part shown inFIGURE 3, the structure in this figure being complementary to thecorresponding structure shown in FIGURE 2, also illustrating in dottedlines the complementary part shown in FIGURE 2 in position in FIGURE 9.

FIGURE 11 is a detailed sectional view, taken on the line 11-11 ofFIGURE 1, of the means which serves to lock the two principal parts inthe position shown in FIGURES l and 6, the means being precalibrated tocontrol the pressure exerted at the opposite ends of the device, moreparticularly, the pressure applied by the cylindrical heads when theyare in the operative position shown in FIGURE 1.

FIGURE 12 illustrates a form of retaining ring, the illustration being aview in side elevation.

FIGURE 13 is a sectional view along the axis of the retaining ring shownin FIGURE 12.

FIGURE 14 illustrates a second and especially preferred form of a deviceconstructed in accordance with the invention, the drawing being afragmentary top plan view showing, in detail, only the portion of thedevice beyond the pivot point of the instrument. For purposes ofconvenience, in describing the illustrations, two principal partsillustrated in this figure are labeled C and D.

FIGURE 15 is a side view of FIGURE 14 showing in particular principalpart D.

FIGURE 16 is an inside view of one of the illustrated parts of FIGURES14 and 15, namely principal part C, the illustration showing thesections of the head portion separated so as to permit withdrawal of theinstrument from its position about a blood vessel, the manipulatinglever being in depressed position.

FIGURE 17 is a fragmentary view in side elevation illustrating therelationship of the working surfaces (cylindrical head portions) of theinstrument, the body ducts being omitted for purposes of clarity, whenthe working surfaces approach each other prior to being pressed intotheir final working relationship.

Referring to FIGURE 1 of the drawings, there is illustrated a devicesomewhat like forceps, having two principal parts A and B carryinghandle portions denoted by numeral 20 adjacent their lower ends,elements A and B being assembled about a common pivot section denotedgenerally at 22 and being held firmly in the position shown in FIGURE 1by the locking structure indicated generally at 24.

Numeral 26 denotes a pair of similar cylindrical head portions and, asmay be seen in FIGURE 6, numeral 28 denotes a blood vessel to which thedevice has been applied and manipulated so as to bring the ends oftheblood vessel into apposition. As will be seen, the blood vessel is heldfirmly between the heads 26 and, because of having been cuffed about thehead portions, there is a flanged area of each end of the blood vesselupstanding and extending outwardly from the heads in a positionappropriate for applying the closing sutures, or for otherwise effectinganastornosis of the severed vessels.

The two principal parts A and B of the device are shown separately andin greater detail in FIGURES 2 and 3. Referring to FIGURE 2, numerals 30and 32 denote slender shank portions having a broadened intermediatesection denoted by numeral 34. As will be seen,

shank portions 30 and 32 extend from generally opposite points on thebroadened section 34. The details of the it is desired to separate thetwo broadened portion 34 are more plainly observable in FIGURES 7 and 8and comprise the customary forcepslike pivot area complementary to aco-operating portion to be referred to in describing FIGURE 3. Numeral36 denotes a toothed latch element which, together with a like element38 depending from the lower portion of the part B of FIGURE 3, comprisesa preealibrated lock for parts A and B when they are in the positionshown in FIGURE 1. This general latch construction is well known and isnot believed to require further detailed description; however, it shouldbe understood that in this instance the elements 36 and 38 comprisesomething more than a simple latch inasmuch as they are precalibrated toprovide locking of the two parts together in such a position thatsuflicient pressure is delivered to the circular faces of the headportions where they bring the ends of the blood vessels together as inFIGURE 6, that there is no leakage in the course of rejoining the vesseland, at the same time, excessive pressure as would injure the bodytissue is not applied. As will be seen in FIGURE 11, the two elements 36and 38 consist of toothed members, the angle of the teeth being such asto provide a locking engagement therebetween.

Referring to FIGURE 3, numerals 40 and 42 denote slender shank portionsjoined by an intermediate section 44, the latter section being morefully illustrated in FIG- URES 9 and 10 and comprising the complementarypivotal element to that of numeral 34 of FIGURE 2, whereby theforceps-like pivotal action is afforded when the two parts are inassembled relation.

Referring to FIGURES 9 and 10 of the drawings, numeral 46 denotes apivot pin adapted to receive the cooperating part A which is providedwith a cooperating bore 48. Numerals 50 and 52 denote flanges underwhich broadened section 34 of part A lies when the parts A and B are inthe position shown in FIGURE 1. When parts A and B, they are rotatedabout the pivot pin 46 to a point where the broadened section 34 is freeof the overlapping flanges 50 and 52, at which point, the two parts Aand B are easily separated by lifting part A free of the pivot pin 46.

The side surfaces of broadened portion 34 which passes beneath flanges50 and 52 are machined to a degree which permits free rotation of partsA and B about pivot 46 to a point where heads 26 abut and furtherthereafter permit the relative motion of the handle portions of A and Btoward each other whereby to apply the needed pressure engagementbetween ihead members 26.

Referring again to FIGURES 2 and 3 of the drawings, it will be observedthat the cylindrical head portions 26 depend from their respectivesupporting shank sections 3 0 and 40 in opposite directions so that whenin the position shown in FIGURE 1, similar faces are presented to eachother. It should be noted that shanks 3t) and 40 extend from the outsidefaces of the cylindrical heads so that the said shank portions offer noobstruction to the cufiingcf the ducts.

Referring to FIGURE 4, which drical head portions 26 on an enlargedscale, numeral 54 denotes a flanged, g nerally cylindrical, sleeveportion having its outer surface machined to provide a relatively broadshallow groove 56 extending in a circular direction with respect to thesleeve 54. The groove may be regarded as being formed by circularflanges. 58 and 60. The reason for this construction will become moreapparent at a later time. The internal surface of the sleeve isentzrelysmooth and machined to provide good frictional engagement withthe surfaces of the bushing elements. As may be seen in FIGURE 5, thesleeve 54 is open as indicated at numeral 62 for the purpose, asexplained above, of permitting passage of the blood vessel from theconfines of the sleeve when it has been rejoined.

Referring again to FIGURE 4 of the drawings, there is illustrated atwo-part bushing which parts are denoted shows one of the cylinbynumerals 64 and 66. The bushing may be clearly seen in position withinthe sleeve in FIGURES 5 and 6. Both parts 64 and 66 are identical andcomprise semi-circular sections of cylinders having circular flanges 68which provide bearing surfaces when the parts A and B are in appositionas shown in FIGURE 6, thereby assuring complete and uniform contactof'the blood vessels at the time they are being sutured. Also, theflanged surfaces 68 serve to provide a relatively broad continuousbearing surface whereby to aid in avoiding cutting of the blood vesselwhen the necessary pressure is applied to stop the flow of blood at thepoint of apposition of the blood vessel. Additionally, it should benoted that flanges 68 aflord assistance in removing the bushing elementsfrom their operative position within the sleeve when the suturing hasbeen completed. It will be understood that the bushing elements when inposition adjacent the inner surfaces of the cylindrical sleeves havetheir flange portion 68 adjacent the flange portions 58 of the sleeveitself.

Referring to FIGURES 12 and 13 of the drawings, there is illustrated aretaining ring denoted by numeral 70. Two such rings are desirable foruse in conjunction with the device of the invention, they serving thepurpose of retaining the cuffed portions of the blood vessels securelyupon the heads 26 while the heads are being brought into the positionshown in FIGURE 6. When the retaining rings have served this purposethey are severed and removed. Desirably, they are constructed of rubberand of such size as to afford firm yet not undue pressure upon thevessel cuffs.

Having described one of the devices illustrative of the invention, it isdesired to explain its operation in actual use.

It will be understood that at the time the device is placed in use, theblood vessels have been clamped and severed and that the time hasarrived for the rejoining of the blood vessels ends.

Considering a severed blood vessel having an end to the right and an endto the left as one views the site of the operation, parts A and B beingseparated at their pivot points and having their bushing elements inplace, part A is passed over the right blood vessel end so that theblood vessel extends axially of the cylindrical head. The end of theblood vessel is culled closely adjacent the flanged faces 68 andretaining ring 70 is applied to secure the vessel and head in fixedengagement. Part B of the device is then applied to the left bloodvessel end and similarly firmly positioned with respect to the bloodvessel. The handles are then exchanged in their relative positions so asto pass the handle of part A over part B and bring the broadened portion34 of part A into position for reception of the pivot pin 46 of part B.The two parts are in operative engagement when the bore is fully seatedabout the pivot pin. The handles of the device are then brought into thelocking position shown in FIGURE 1, in the course of which, the bloodvessels are brought into apposition as shown in FIGURE 6 and upper andlower portions of the broadened section 34 have passed beneath theflanges 50 and 52 of part B, the latch elements engage thereby securelyuniting the two elements A and B and assuring that there will be nochanging of position of the blood vessels with respect to each otheruntil such time as parts A and B have been released from their lockedengagement as provided by elements 36 and 38.

The retaining rings 70 are then severed and removed from their positionabout the blood vessel cuffs and the cuffs are turned up to presentabutting circular flanges for suturing. The suturing having beencompleted, locking elements 36 and 38 are disengaged by the applicationof slight pressure to the handles 20, and parts A and B are gentlyrotated about pivot pin 46 to a point as indicated in FIGURE 9, wherethey can be disengaged by the reverse of their joining. It will now beunderstood that when moving the parts A and B away from each other, thehead portions 26 must necessarily slide along the surfaces of the bloodvessels to a point somewhat remote from the point of suturing. Each ofparts A and B are then separated from each other and separately removedfrom their positions about the blood vessels. This is accomplished byinserting a knife edge between abutting flanges 56 and 68 and applying agentle force axially of the head 26, there-by sliding bushings 66 fromtheir position within the sleeve 54 and in so doing, leaving the openingexisting between ends 62 of the sleeve unobstructed. It will beunderstood that the bushings from both parts A and B are removed. Thishaving been accomplished, parts A and B may be removed by passing thevessel through the opening in the sleeve. At this point, the use of thedevice is at an end and it is removed from the site of the operation forcleaning.

The construction and operation of the second form of the invention asillustrated in FIGURES 14 through 16 will now be described. Beforeproceeding to the detail of the description, it may be noted that thesecond form is in all respects similar in construction and operation tothat of the inventive form described above insofar as the pivot sectionof the forceps handles and the latchpressure control mechanism areconcerned. For this reason, the illustrations of FIGURES 14 and 16 arefragmentary thus avoiding needless repetition.

Referring to FIGURE 14 of the drawings, numeral 72 denotes generallycylindrical flanged head portions in substantially abuttingrelationship, and numeral 74 denotes a blood vessel in position withinthe cylindrical heads for rejoining. Numeral 76 denotes a pair of leverarms to which are attached sections of the cylindrical heads. Numeral 7%denotes fragmentary portions of the forceps shanks and the pivot areatherefor.

I Referring to FIGURE 15, numeral 80 and numeral 82 denote cooperatingarcuate sections of the cylindrical heads 72, the points of division ofthe cylindrical head being denoted by numeral 84. As will be seen, thetwo sections as shown are approximately semicircular, the sectiondenoted by numeral 80 being mounted on lever arm 76 for movement awayfrom the section denoted by numeral 82 as may be seen in FIGURE 16. Itwill be understood that the sections may be any degree of are asdesired, it being important only that they complete 360 and that thesmaller section provide a passageway sufliciently large to permit easyremoval from the blood vessel.

Numeral 86 denotes downwardly turned flanges depending from the leverarm serving to form a fulcrum point and mounting means for the lever armupon the underlying shank, there being a pin 96 passing through theflanged portions and the shank of the instrument proper.

Mounted between the lever arm 76 and the shank portion 78 is acompression spring denoted by numeral 92 normally holding the lever armin a position which places the sections of the cylindrical heads in theclosed position shown in FIGURE 15. Numeral R4 denotes an upstanding earrigidly mounted on each shank portion 78, the ear serving as a guardagainst lateral movement of the sections 8t when they are in theposition shown in FIGURE 14 and under pressure necessary to hold theends of the blood vessel in proper relation.

The use and operation of the device is generally similar to thatillustrated in FIGURES 1-13 except that removal of the device from itsposition about the blood vessel after the work of rejoining is completedis effected simply by depressing lever arms 76, a may be seen in FIGURE16, thereby opening the cylindrical head portions sufiiciently to allowthe instrument to be drawn away.

All of the parts of the devices of'the invention preferably are ofsurgical steel, highly polished for purposes of cleanliness. As willhave been observed in the course of considering the drawings and thedescription herein presented, the devices of this invention aresubstantially the ultimate in simplicity of use and design with theresult that their purpose may be accomplished with great savings of timeand little danger of introducing infections at the site of theoperation.

The devices may be employed in rejoining ducts of different sizes byproviding head portions corresponding to the various range of ductsencountered in the course of operations. As will be readily understoodthe head portion described herein may be attached in a manner to ermittheir easy removal and replacement by heads of different size.

It is desirable to point out a particular feature of the devices notheretofore touched upon, which feature concerns the angles that thecircular flanged surfaces, between which the duct is held, make withrespect to a vertical line passing between them at the instant when thetwo heads first touch. Preferably, the devices are designed so that theheads 26 first touch upon a point adjacent their uppermost portion whenthe device is held in a vertical position with the heads at the top andthe handles at the bottom, and that the heads depend from this point ata small angle to the vertical thereby leaving a small space between thelowermost points of the heads, i.e., the point adjacent their extremebottom edges. It follows from what has just been stated, that when thetwo heads first touch, the two circular flanged surfaces do not have allpoints in a common plane; rather, they flare outwardly somewhat at theirlower edges. This feature is found to be important in providingsubstantially uniform pressure at all points between circular flangedsurfaces whereby to maintain the ducts under uniform pressure, and undersufiicient pressure at all points so that leakage does not occur. It hasbeen found that when the two heads first touch, if they touch at allpoints on the circular flanges, i.e., all points lie in a commonvertical plane upon first touching, when pressure thereafter is appliedby squeezing the handles of the device, the lower edges of the circularflanges tend to act as a pivot point and, depending upon the amount ofpressure applied, they tend to flare upwardly, thereby at leastlessening the pressure about the top edges of the flanges and mayactually separate along the top edges. As will be appreciated, this is amatter of design to be taken into consideration in the construction ofthe devices.

Referring to FIGURE 17 of the drawings the relationships just describedis illustrated, the body ducts, for example, blood vessels being omittedfor purposes of clarity in illustration. Of course, as will beunderstood, in actual usage the bare surfaces of the instrument do nottouch, as they are covered by the blood vessels. In this figure, numeral96 denotes the apex of the angle formed between the working surfaces,numeral $8 denoting the angle itself. When the working surfaces, that isthe cylindrical head portions 26, are in the relative positionillustrated in FIGURE 17, the final pressure necessary upon theinstrument is yet to be applied, whereby the heads move into theposition illustrated in FIGURE 6, where the blood vessels are actuallyshown in the position for suturing. In movement of the cylindrical headsto the position of FIGURE 6 from that position of FIG- URE 17, slightbending of the steel structure takes place, the point 96 acting as thefulcrum point. As will be appreciated, as the surfaces move to theposition of parallelism of FIGURE 6, the pressure therebetween isgradually evenly distributed over the entire working surfaces where theends of the blood vessels come into contact.

While it is believed to be perfectly clear from the foregoing as regardsthe point of first contact of the working surfaces, such point may befurther located as lying substantially midway between the ends of and inthe arcuate portions of the working surfaces which depend outermost ofthe device.

Having the teachings of the application before them, it will beappreciated by those skilled in the art that the construction of thedevice to the purpose that the working surfaces will first contact eachother at a point as described above may take several forms. For example,the shank elements may have a slight bend in order to angle the workingsurfaces, or the bodies which carry the working surfaces may be angledslightly relative to the shank elements. Still other constructions willoccur to those skilled in the art.

Having described the details of the devices and the manner of theiroperation, it is desired to emphasize certain aspects of the inventionwhich are considered to be outstandingly important.

One aspect to be especially noted is the pivot area. The pivot areawhich affords separability of the two shank portions of the devices isfelt to be highly desirable for the reasons that it permits manipulationof the shank portions individually, and the device as a whole is moreeasily and thoroughly cleaned than is the case Where the two parts arepermanently joined.

The use of the bushing elements as a means of providing the circularflanged bearing surfaces, and which close the slots in the outersleeves, is felt to be highly desirable for the reasons that easycleaning of the device is permitted and that some economic advantage canbe gained by using bushings of different sizes whereby to adapt thedevice for different size ducts, and thus save on the capital investmentrequired for a complete stock of instruments. It will, of course, beunderstood that different size bushings can be used only in instanceswhere the ducts being rejoined have sufficient flexibility to permittheir being drawn over the flange surfaces for cutting. In thisconnection, for example, veins provide much more expansivity than doarteries. Although it is not necessary that the bushing be separated soas to provide two sections of equal arcuate dimensions, it is desirablethat they be so separated since where the two parts of the bushing areequal in size, bushings are interchangeable between instruments andavoid the necessity of selecting a particular size. Where they are ofdifferent size, the selection task becomes troublesome especially wherethe bushings are quite small.

It will be understood that as a practical matter, the aspect of pressurewhich the devices develop between the head members is one which canhardly be discussed in units insofar as a particular instrument isconcerned, because of the fact that the pressure to be applied islargely a matter for the decision of the surgeon considering the age ofthe patient, the condition of the duct, and the particular duct itself,i.e., whether it be a blood vessel, bile duct, or other duct.Accordingly, it is desirable that in constructing the devices,sufficient latitude between substantially zero pressure and an outsidedamaging degree of pressure be provided, thus affording the surgeon aswide a choice as possible. Within these limits, it is desirable to havea substantially infinitely variable pressure control. It may be remarkedthat this aspect of the present devices finds its substantial analoguein the art of the hem-ostat. If desired, a suitable member may be placedon the inner surface of the shank portions of a dimension such as tolimit positively the amount of pressure which can be placed upon thecylindrical heads. Such a member is shown in FIGURE 14 of the drawingsas denoted by numeral 96. Thus, even though the portion of theinstrument including the forceps handles might be flexed by additionalpressure, such pressure could not be transmitted to the heads.

It is desired to point out that some of the functions of this inventionmay be accomplished by structures differing from the specific form ofthe invention disclosed herein; however, not without incurring somedisadvantages and losing some of the advantages afforded by the specificform disclosed. For example, the slot in the outer sleeve portion of thecylindrical head could be supplied with a suitable shaped completelydetached insert whereby to close it while the device is holding theblood vessel, thereby eliminating the bushing elements and the leverarrangement. Such an insert might be an entirely separate complementarysmall piece of self-locking configuration.

While the invention herein has been described with respect to particularembodiments, those skilled in the art will appreciate that variousmodifications within the scope of the invention may be derived from theteachings herein. Accordingly, this invention is not to be restrictedunduly and is to be understood to extend to all modifications which fiowfrom the teachings herein.

What is claimed is:

1. A surgical device especially adapted for use in the rejoining ofsevered tubular body ducts such as blood vessels, bile ducts and thelike, comprising a pair of elongated similar elements, each of which isprovided with finger holding means on one end and each being provided onthe opposite end with a body providing a working surface, said elementsbeing pivotally connected intermediate their ends for relative pivotalmovement whereby the said bodies are moved to and from their workingposition in the manner of forceps and the like; said bodies each havinga generally cylindrical form, and each having axially therethrough agenerally circular channel whereby to receive said tubular body ducts;each of said bodies having discontinuous outer walls thereby affordingpassageways to the exterior of said bodies from said openings; meansmovable with respect to each of said bodies for closing saidpassageways; said bodies, in their movement to final working positionunder finger. manipulation of the said holding surfaces, first meetingat substantially a single point on their working surfaces, said pointlying substantially midway between the ends of and in the arcuateportions of the Working surfaces of said bodies which depend outermostof said device, said point determining the apex of and defining an angleextending between said working surfaces of said bodies and inwardly ofsaid device, said point thereupon acting as a fulcrum point relative tosaid bodies, and said angle decreasing as said bodies are moved intotheir final working position, said bodies being in substantial point topoint contact about their opposing working surfaces in said finalworking position and having their cylindrical axes. substantiallycoincident; said holding means affording the user the development of acontrolled amount of pressure between said surfaces, and meansassociated with said elements for restraining movement of said workingsurface from their working position and maintaining said pressure.

2. A device as claimed in claim 1 wherein said working surfaces areprovided by a pair of cooperating generally circular flanged surfaces,each of said pair of flanged surfaces depending radially outwardly fromgenerally cylindrically shaped bushing elements, which elements define agenerally circular channel, said bushing elements comprising at leasttwo arcuate segments of cylindrical configuration; said bushings when inworking position being contained within said cylindrical bodies and eachof said bodies having a slot therein extending through the wallsthereof, said bushings being removable from said bodies and normallyunderlying said slots thereby providing walls obstructing said slots.

3. A device as claimed in claim 1 wherein each of said elements isprovided with an arcuate, generally cylindrical segment extendingradially from its working end, and a spring-urged lever arm carrying asecond segment, complementary to said first segment, pivotally mountedon each said elements, said complementary segment extending from theworking end of said lever arm and normally being urged into the positionforming with said first segment said cylindrical ibodies, therebydefining said generally circular channel for the axial reception of saidtubular body ducts.

4. A device as claimed in claim 1 wherein said elements are separablefrom each other.

5. A device as claimed in claim 2 wherein said elements separable fromeach other.

6. A device as claimed in claim 3 wherein said elements are separablefrom each other.

References Cited by the Examiner UNITED STATES PATENTS 1,151,300 8/1915Soresi 128--334 X 2,632,661 3/1953 Cristofv 128321 2,895,478 7/1959 Post128-334 2,940,451 6/1960 Voge-lfanger et al. 128334 2,965,900 12/1960Inokouchi 128334 X 3,048,177 8/1962 Takaro 128334 3,144,654 8/1964Mallina et a1. 1349 X FOREIGN PATENTS 984,590 2/1951 France. 836,548 4/1952 Germany.

RICHARD A. GAUDET, Primary Examiner.

DALTON L. TRULUCK, Examiner.

1. A SURGICAL DEVICE ESPECIALLY ADAPTED FOR USE IN THE REJOINING OFSEVERED TUBULAR BODY DUCTS SUCH AS BLOOD VESSELS, BILE DUCTS AND THELIKE, COMPRISING A PAIR OF ELONGATED SIMILAR ELEMENTS, EACH OF WHICH ISPROVIDED WITH FINGER HOLDING MEANS ON ONE END AND EACH BEING PROVIDED ONTHE OPPOSITE END WITH A BODY PROVIDING A WORKING SURFACE, SAID ELEMENTSBEING PIVOTALLY CONNECTED INTERMEDIATE THEIR ENDS FOR RELATIVE PIVOTALMOVEMENT WHEREBY THE SAID BODIES ARE MOVED TO AND FROM THEIR WORKINGPOSITION IN THE MANNER OF FORCEPS AND THE LIKE; SAID BODIES EACH HAVINGA GENERALLY CYLINDRICAL FORM, AND EACH HAVING AXIALLY THERETHROUGH AGENERALLY CIRCULAR CHANNEL WHEREBY TO RECEIVE SAID TUBULAR BODY DUCTS;EACH OF SAID BODIES HAVING DISCONTINUOUS OUTER WALLS THEREBY AFFORDINGPASSAGEWAYS TO THE EXTERIOR OF SAID BODIES FROM SAID OPENINGS; MEANSMOVABLE WITH RESPECT TO EACH OF SAID BODIES FOR CLOSING SAID PASSAGEWAY;SAID BODIES, IN THEIR MOVEMENT TO FINAL WORKING POSITION UNDER FINGERMANIPULATION OF THE SAID HOLDING SURFACES, FIRST MEETING ATSUBSTANTIALLY A SINGLE POINT ON THEIR WORKING SURFACES, SAID POINT LYINGSUBSTANTIALLY MIDWAY BETWEEN THE ENDS OF AND IN THE ARCUATE PORTIONS OFTHE WORKING SURFACES OF SAID BODIES WHICH DEPEND OUTERMOST OF SAIDDEVICE, SAID POINT DETERMINING THE APEX OF THE DEFINING AN ANGLEEXTENDING BETWEEN SAID WORKING SURFACES OF SAID BODIES AND INWARDLY OFSAID DEVICE, SAID POINT THEREUPON ACTING AS A FULCRUM POINT RELATIVE TOSAID BODIES AND SAID ANGLE DECREASING AS SAID BODIES ARE MOVED INTOTHEIR FINAL WORKING POSITION, SAID BODIES BEING IN SUBSTANTIAL POINT TOPOINT CONTACT ABOUT THEIR OPPOSING WORKING SURFACES IN SAID FINALWORKING POSITION AND HAVING THEIR CYLINDRICAL AXES SUBSTANTIALLYCOINCIDENT; SAID HOLDING MEANS AFFORDING THE USER THE DEVELOPMENT OF ACONTROLLED AMOUNT OF PRESSURE BETWEEN SAID SURFACES, AND MEANSASSOCIATED WITH SAID ELEMENTS FOR RESTRAINING MOVEMENT OF SAID WORKINGSURFACE FROM THIER WORKING POSITION AND MAINTAINING SAID PRESSURE.